On September 9th, CMS updated the dedicated Face-to-Face (FTF) for DMEPOS webpage to reflect the changes imposed by The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). In the update, CMS clarifies that the completion of the face-to-face encounter to qualify a patient for DMEPOS may be conducted and completed by a physician, nurse practitioner (NP), physician assistant (PA) or clinical nurse specialist (CNS). Prior to the passing of MACRA, the face-to-face encounter required a physician sign off when documented by an NP, PA or CNS; which prompted a number of concerns for those professionals operating independent of a physician as allowed in many states.

The FTF rule for DME became effective in July of 2013 with a delay of enforcement by auditing contractors (excluding the CERT) due to supplier readiness concerns. CMS then announced the enforcement of just one piece of the ruling (which MiraVista has commonly referred to as Phase 1) which requires that the patient have a face-to-face visit within 6 months of the written order and the supplier must obtain a detailed written order which must include the physician’s NPI. This detailed written order must be date stamped prior to delivery of the equipment. The second phase, which has yet to be enforced, will require suppliers to obtain a copy of the documented face-to-face encounter to qualify the patient for each piece of DME. When enforced the face-to-face chart notes will have to be date stamped prior to delivery. The first phase began enforcement for written orders dated on and after January 1, 2014. However, we are still operating under an undetermined delay for Phase 2. The industry speculated that after the passing of MACRA, CMS had cleared the way to begin enforcement of Phase 2. However, in the most recent update CMS stated that they “will not start actively enforcing or expect full compliance with the DME face-to-face requirements until further notice.”While the industry waits for additional guidance on enforcement of the second phase, suppliers should continue to prepare by improving intake protocols and capturing required documentation while the quid-pro-quo with the physician still exists. MiraVista contends that suppliers stand to gain the most by communicating with referral sources when the information is fresh in their minds. Proper screening and a solid understanding of documentation requirements enables suppliers to secure reimbursement up front, verses chasing it down the road. MiraVista will continue to monitor the progress of the FTF initiative, so be sure to stay tuned to our blog and weekly newsletter.